Efficacy and safety of probiotics, prebiotics and synbiotics in the treatment of irritable bowel syndrome : a systematic review and meta-analysis

• Published in: Sultan Qaboos University medical journal Vol. 20; no. 1; pp. 13 - 24
• Main Authors: Asha, Muhammad Zaki, Khalil, Sundus Falih Husni
• Format: Journal Article
• Language: English
• Published: Muscat, Oman Sultan Qaboos University, College of Medicine and Health Sciences 01-02-2020; Sultan Qaboos University; Sultan Qaboos University Medical Journal, College of Medicine & Health Sciences
• Subjects: Abdomen; Citation management software; Disease; Intervention; Irritable bowel syndrome; Meta-analysis; Microbiota; Pain; Prebiotics; Probiotics; Review; Studies; البريبيوتيك; القولون العصبي; المكملات الغذائية; United States > US; Probiotics; Meta-Analysis; Irritable Bowel Syndrome; Systematic Review; Gastrointestinal Microbiome; Dietary Supplements; Synbiotics; Prebiotics
• ISSN: 2075-051X; 2075-0528
• DOI: 10.18295/squmj.2020.20.01.003

Treatments that target alterations in gut microbiota may be beneficial for patients with irritable
bowel syndrome (IBS). A systematic review and meta-analysis was conducted of randomised clinical trials (RCTs)
evaluating the efficacy and safety of probiotics, prebiotics and synbiotics. Factors considered in the analysis
included global IBS symptoms and/or abdominal pain, secondary symptoms and the frequency of adverse events.
A total of 33 RCTs involving 4,321 patients were identified. Overall, probiotics significantly improved global IBS
symptoms compared to placebos (standardised mean difference = −0.32, 95% confidence interval: −0.48 to −0.15;
P <0.001), with significant heterogeneity between studies (I2 = 72%; P <0.001). This remained apparent in both
single- and multi-strain probiotic interventions as well as synbiotic formulations. However, evidence regarding
prebiotics was scarce. There were no significant inter-group differences in terms of the frequency of adverse events.
Future RCTs should address methodological limitations, including short follow-up periods and patient adherence.